The medical treatment of trigeminal neuralgia

Abstract

The French guidelines for the treatment of trigeminal neuralgia have been recently published. The first-line medical treatment is carbamazepine 400–1 600 mg per day according to the patient’s response. The daily dosage should be increased gradually, with 2 or 3 doses per day. Side effects, common in the elderly (drowsiness, dizziness with vestibulo-cerebellar syndrome), should be monitored. Oxcarbazepine may be used in case of intolerance to carbamazepine. In the event of intolerance or failure of both previous treatments, lamotrigine may be used. Baclofen may be used alone or in combination with carbamazepine or oxcarbazepine. Other antiepileptics are not recommended as firstline drugs, but are used in practice in the event of failure or intolerance to carbamazepine, oxcarbazepine or lamotrigine. These are gabapentin, pregabalin, topiramate and levetiracetam.